Tabrizi Nika Samadzadeh, Shapeton Alexander D, Ortoleva Jamel, Burmistova Michelle, Demos Riley A, Musuku Sridhar R, Schumann Roman
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH, United States.
Department of Anesthesia, Critical Care and Pain Medicine, Veterans Affairs Boston Healthcare System and Tufts University School of Medicine, Boston, MA, United States.
Saudi J Anaesth. 2025 Jul-Sep;19(3):334-344. doi: 10.4103/sja.sja_738_24. Epub 2025 Jun 16.
Immediately following esophagectomy, aspiration is responsible for most direct postoperative complications, largely attributed to anatomical alterations from the surgical procedure. The long-term risk of aspiration following successful esophagectomy has not been systematically investigated, and there are no guidelines for the anesthetic management of postesophagectomy patients who require elective surgeries involving general anesthesia (GA).
PubMed/MEDLINE, Embase, and Web of Science were systematically searched from inception through January 1, 2024 to identify studies involving patients ≥90 days postesophagectomy and undergoing elective surgery unrelated to their esophagectomy status, where GA was required. Data on perioperative anesthetic management were extracted. The primary outcomes assessed were perioperative gastrointestinal and pulmonary complications. Secondary outcomes included the approach to induction of GA and author recommendations.
Of the 4097 studies, ten studies involving 131 patients met inclusion criteria. Intraoperatively, adverse events during induction occurred in 13.0% of 131 cases, including regurgitation of gastric contents in 5.3% and pulmonary aspiration in 9.9%. The airway was managed with an endotracheal tube in 95.6%. Induction was performed in the semi-Fowler position in 92.9% and performed using the rapid sequence and standard induction techniques in 58.7% and 41.3%, respectively.
Patients who have undergone esophagectomy may remain at high risk for aspiration during GA even in the long term, necessitating enhanced vigilance in anesthetic management. We offer evidence-informed suggestions for elective induction of GA in patients with a history of successful esophagectomy to enhance safe practice for these patients.
食管切除术后，误吸是导致大多数直接术后并发症的原因，这在很大程度上归因于手术造成的解剖结构改变。食管切除术后成功的患者发生误吸的长期风险尚未得到系统研究，对于需要接受全身麻醉（GA）的择期手术的食管切除术后患者，也没有麻醉管理指南。
对PubMed/MEDLINE、Embase和Web of Science进行系统检索，从数据库建立至2024年1月1日，以识别食管切除术后≥90天且接受与食管切除术无关的择期手术且需要全身麻醉的患者的研究。提取围手术期麻醉管理的数据。评估的主要结局是围手术期胃肠道和肺部并发症。次要结局包括全身麻醉诱导方法和作者建议。
在4097项研究中，10项涉及131名患者的研究符合纳入标准。术中，131例中有13.0%在诱导期间发生不良事件，包括5.3%的胃内容物反流和9.9%的肺误吸。95.6%的患者通过气管内插管进行气道管理。92.9%的患者在半福勒位进行诱导，58.7%和41.3%的患者分别采用快速顺序诱导技术和标准诱导技术进行诱导。
即使在长期内，接受过食管切除术的患者在全身麻醉期间仍可能面临误吸的高风险，因此在麻醉管理中需要提高警惕。我们为有成功食管切除术病史的患者进行全身麻醉的择期诱导提供基于证据的建议，以提高这些患者的安全操作水平。
